I'm looking for assistance for our pedi (and rehab) nurses about managing administration sets. Their practice is to disconnect pedi (and rehab) patients from their administration sets in between meds so they have more mobility. They're concerned about the cost of replacing them every 24 hours.
We've spoken about the much higher cost of PIV and CLBSI morbidity and mortality and they understand. These nurses are involved in our quality teams on central line care and education, and are fairly open minded.Â
How have others managed this?
There is absolutely no research that has ever been done (that I can find) on the frequency of changing intermittent sets. CDC does not make a difference in the use of each set - continuous vs intermittent - however INS standards of practice does separate these 2 uses. Sets used for continuous infusion should ***only*** be disconnected for the purpose of changing the tubing every 72 or 96 hours. Any other reason for disconnection is not valid in my opinion. It increases hub manipulation, a major cause of CRBSI and it alters therapeutic response to the infusing fluid/meds. Sets used for intermittent infusion require changing every 24 hours because they are manipulated on both ends with each dose and there is no research to support their use beyond the original limit of 24 hours. CDC also states that all catheter must be accessed with a sterile device. Do you really think that an intermittent set that has been used for these longer periods are still sterile? We are focusing so much attention on the infections caused by needleless connectors, but I firmly believe that we must stop and look at everything we are attaching to them. If we continue to attach sets that have huge levels of contamination (uncapped, blood back up into them, looped to a higher injection site, etc) how can we blame the needleless connector exclusively for the BSI?
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thanks, Lynn - I agree with what you're saying, and have had the same discussion with the nurses.
What surprised me was that management is supportive of this practice, understands the principles of asepsis and closed infusion systems knowing that the cost of tubing would increase - because they don't always seem to be able to look outside of the month-month budget. However, I'll bet they do have a micro AND macro perspective with the CMS changes looming - maybe that is why they accepted the changes so readily.
So, what I'm looking for are some stories about this situation has played out in practice for other facilities. I go 'door to door' and give staff concise visual and statistical bytes and my personal time, but they are the ones that seem to be having a hard time with changing their practice - leaving me scratching my head.
Mari Cordes, BS RN
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
Well, the only one who really likes change is a wet baby! Nurses are no different with behavior changes. I hope people do post their stories as I would also love to read them!
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861